Coping and adaptation theory is used to synthesis existing data concerning psychological recovery from acute spinal cord injury. Psychological reactions to spinal cord trauma are similar to those of mourning and other situations of severe loss. Each reaction plays a specific role in fostering or hindering recovery depending upon when it occurs. Premorbid personality and the influence of significant others play a central role in coping with injury. These factors partly explain why some patients cope better than others to equally serious disability. A critique of research methodologies and suggestions for new studies are provided.